{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,16]],"date-time":"2026-04-16T17:48:38Z","timestamp":1776361718144,"version":"3.51.2"},"reference-count":8,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2024,12,5]],"date-time":"2024-12-05T00:00:00Z","timestamp":1733356800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2024,12,5]],"date-time":"2024-12-05T00:00:00Z","timestamp":1733356800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["agsjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J American Geriatrics Society"],"published-print":{"date-parts":[[2025,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Randomized controlled trials (RCTs) of complete revascularization (CR) versus culprit\u2010only revascularization (COR) in patients with ST\u2010elevation myocardial infarction (STEMI) have shifted the recommendation for CR from class III to class I in the AHA\/ACC\/SCAI guidelines, but it remains unclear if the benefit of CR over COR extends to older adults, who have greater bleeding risk, comorbidity burden, and complexity of lesions. We performed a meta\u2010analysis to place the results of the previous RCTs in the context of the recently published FIRE trial and the subgroup analysis of the COMPLETE trial in adults \u226575\u2009years old.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We searched the literature from inception to October 21, 2023. RCTs of CR versus COR in STEMI were selected if it reported results for older adults, defined as either age\u2009&gt;\u200965\u2009years or\u2009&gt;\u200975\u2009years. Integrated hazard ratios (HRs) were calculated using random effects models. The primary outcome was major adverse cardiovascular events (MACE). Secondary outcomes were major bleeding and contrast\u2010associated acute kidney injury (CA\u2010AKI).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      In this meta\u2010analysis of 5 RCTs including 3513 older adults, CR was associated with a lower hazard of MACE than COR (HR 0.60, 95% CI 0.37\u20130.99,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.047). Sensitivity analysis including trials that defined older adults as age\u2009&gt;\u200965\u2009years resulted in a lower hazard of MACE with CR versus COR, but not in trials that defined older adults as age\u2009&gt;\u200975\u2009years. There was no difference in the hazard of major bleeding or CA\u2010AKI between CR and COR.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In this largest meta\u2010analysis to date investigating CR compared with COR in older adults with STEMI, CR was associated with reduced MACE without a concomitant increase in major bleeding or CA\u2010AKI compared with COR. These results can help cardiologists and geriatricians involved in shared decision\u2010making with patients and caregivers when contemplating whether to pursue CR in older adults.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jgs.19295","type":"journal-article","created":{"date-parts":[[2024,12,6]],"date-time":"2024-12-06T01:24:22Z","timestamp":1733448262000},"page":"874-880","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Complete revascularization versus culprit\u2010only revascularization in older adults with\n                    <scp>ST<\/scp>\n                    \u2010elevation myocardial infarction: Systematic review and meta\u2010analysis of randomized controlled trials"],"prefix":"10.1111","volume":"73","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1486-7452","authenticated-orcid":false,"given":"Dae Yong","family":"Park","sequence":"first","affiliation":[{"name":"Section of Cardiovascular Medicine Yale School of Medicine  New Haven Connecticut USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1390-508X","authenticated-orcid":false,"given":"Jiun\u2010Ruey","family":"Hu","sequence":"additional","affiliation":[{"name":"Department of Cardiology Smidt Heart Institute, Cedars\u2010Sinai Medical Center  Los Angeles California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5141-7920","authenticated-orcid":false,"given":"Jennifer","family":"Frampton","sequence":"additional","affiliation":[{"name":"Section of Cardiovascular Medicine Yale School of Medicine  New Haven Connecticut USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9841-2393","authenticated-orcid":false,"given":"Jennifer","family":"Rymer","sequence":"additional","affiliation":[{"name":"Duke Clinical Research Institute  Durham North Carolina USA"},{"name":"Division of Cardiology, Department of Medicine Duke University Medical Center  Durham North Carolina USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8774-6416","authenticated-orcid":false,"given":"Abdulla","family":"Al Damluji","sequence":"additional","affiliation":[{"name":"Johns Hopkins University School of Medicine  Baltimore Maryland USA"},{"name":"Inova Center of Outcomes Research  Falls Church Virginia USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5745-1636","authenticated-orcid":false,"given":"Michael G.","family":"Nanna","sequence":"additional","affiliation":[{"name":"Section of Cardiovascular Medicine Yale School of Medicine  New Haven Connecticut USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2024,12,5]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2021.09.006"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2024.21547"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1305520"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2014.12.038"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(15)60648-1"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2023.10.004"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacadv.2023.100389"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2300468"}],"container-title":["Journal of the American Geriatrics 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